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Bridging the Gap: Integrating Business Competency in Clinical Child and Adolescent Psychology

Bridging the Gap: Integrating Business Competency in Clinical Child and Adolescent Psychology

By James Childress, CPA
CAC Advisors, &
Armando A. Piña Palacios, PhD
Arizona State University

As clinical child and adolescent psychologists, we’ve mastered the art and science of understanding and addressing mental health challenges. But how prepared are we to translate this expertise into sustainable, impactful practices? The APA’s Competency Framework for Master’s and Doctoral Degree Education and Training in Health Service Psychology (HSP) highlights a significant gap in our training: a lack of preparation in business principles essential for launching and sustaining healthy practices. 

The Challenge: Business Acumen in Psychology Education 

The APA’s Competency Framework acknowledges what many of us have experienced firsthand: clinical psychology training rarely includes comprehensive instruction in the business of psychology. Faculty, while brilliant in teaching clinical interventions and research methods, often lack the expertise to guide students in business operations, healthcare financing, or strategic practice development. 

This gap isn’t just theoretical—it has real-world consequences. Many promising private practices struggle with financial instability, organizational inefficiencies, and clinician burnout, leading to closures that leave patients underserved and teams destabilized.  

At last year’s APA convention, our professional development symposium on this very issue was met with resounding agreement: “We need this!” 

Supporting Directors of Clinical Training (DCTs) 

Recognizing this need, we are launching a series of micro-trainings dedicated to building the business competencies essential for psychologists in private practice. Our goal is to empower psychologists at all career stages—master’s, doctoral, and beyond—with the foundational knowledge to establish and grow thriving practices. 

The APA’s competency framework emphasizes that HSP graduates should: 

• Understand administrative and business operations in healthcare, education, and research settings.
• Apply principles of equity, diversity, and inclusion (EDI) to foster psychologically healthy workplaces.
• Address ethical challenges in administrative roles with confidence and clarity. 

For doctoral-level training, the outcomes go further, focusing on leadership in healthcare financing, grants management, and evidence-based organizational interventions. 

Moving Beyond Bootstrapping 

Many practices operate in what accountants call the “bootstrapping phase”—relying on limited resources and immense personal effort. This approach is unsustainable and risky, especially for solo practitioners. To break out of this cycle, practice owners must transition to a model of intentional growth, systematically addressing areas of risk and laying the groundwork for long-term stability. 

 The 7 Roles Every Practice Needs 

Drawing from business frameworks, we’ve identified seven critical roles that therapy practices must address to grow sustainably: 

1. Chief Executive Officer (CEO): Provides the vision and leadership for the practice. 
2. Chief Financial Officer (CFO): Manages financial planning, budgets, and resource allocation. 
3. Chief Marketing Officer (CMO): Ensures strategic outreach and patient acquisition. 
4. Chief Human Resources Officer (CHRO): Builds and manages cohesive, compliant teams. 
5. Chief Technology Officer (CTO): Oversees data security, compliance, and technological efficiency. 
6. Chief Operations Officer (COO): Implements systems that support daily operations. 
7. Clinical Leadership Officer (CLO): Guides evidence-based patient care and outcomes.  

For smaller practices, these roles don’t require full-time hires; they can often be filled by part-time staff, consultants, or even resourceful outsourcing. 

The Path Forward 

The APA’s framework and the insights of business advisors advocate for a streamlined approach to integrating business training into psychology education: 

• Learn to Delegate: Psychologists don’t need to master every business function. Instead, they need to know how to identify, hire, and manage experts in areas like marketing, finance, and HR.
• Focus on Strategy: Education should prioritize understanding how businesses run over doing every business tasks.
• Start with Financial Planning: Establishing financial clarity is the cornerstone of sustainable practice growth. 

By equipping psychologists with these competencies, we can foster practices that are not only clinically effective but also operationally sustainable. 

First micro-training in the Series: We’ll dive into the role of the CFO in private practices and explore how intentional financial planning can transform your practice from unstable to thriving. Stay tuned!

SUGGESTED READING

Lazarus, J. A. (Ed.). (2007). Entering private practice: a handbook for psychiatrists. American Psychiatric Pub.

Walfish, S., Barnett, J. E., & Zimmerman, J. (Eds.). (2017). Handbook of private practice: Keys to success for mental health practitioners. Oxford University Press. 

About the Authors

James Childress CPA is an accountant for therapists and owner of the firm CAC Advisors. He and his team help practices manage their finances, plan for predictable growth, and achieve their entrepreneurial dreams. His team’s proactive approach has helped many clients double their practice sizes in under three years, all through the power of accounting, data analysis, guidance, and financial forecasting. James lives with his partner and two bossy cats in “the town of Wyoming” as he likes to call it. Please address all correspondence regarding this piece to James@childresscpa.com

Armando A. Piña Palacios, Ph.D. is a member of APA’s Interdisciplinary Minority Fellowship Program’s Professional Development Workbook and a member of the faculty in Psychology at the REACH Institute and the School of Transborder Studies at Arizona State University, Tempe.